- 期刊
耳鼻喉科醫師施行經皮擴張氣切術之可行性及安全性
Feasibility and Safety of Percutaneous Dilatational Tracheotomy by Otolaryngologist
摘要
背景：微創的觀念，是現代外科手術的趨勢。基於針管穿刺與導線輔助下執行的經皮擴張氣切術（percutaneous dilatational tracheotomy, POT）自1985年Ciaglia等提出以來，已被證實在建立長期氣道上為有效、安全的手術。然而PDT的文獻多由危急重症醫師成麻醉醫師發表，且病人來源都是在急重症加護單位內，具氣管插管的危重症患者；臨床上耳鼻喉科醫師執行氣切的患者是更多樣的。此外，國內由耳鼻喉科醫師發表的PDT文章尚付之闕如。本研究的目的，在於證實耳鼻喉科醫師施行PDT的可行性及安全性。方法：採前瞻性，病例系列研究方法，收集自2009年9月至2010年9月在本科執行PDT的病例，由同一位醫師執行，分析病患特徵、適應症、臨床診斷、手術成功率、手術時間、失血量及術中、術後併發症。結果：共計執行40例PDT。男性35例，女性5例，平均年齡62.4歲，平均頸圍41.7cm，平均頸長4.1cm。手術適應症以配合頭頸癌治療之預防性氣切佔最多。手術成功率100％，手術時間平均5.6分，術中失血量統計皆屬微量。手術併發症比率為17.5％。都屬輕度併發症；術中併發症有1例，為氣切管氣囊破裂；術後併發症有6例，氣漏（air leak）為最常見有4例，其餘2例為皮膚切口輕微出血。術後追蹤時間約1個月，無晚期併發症。結論：PDT可由耳鼻喉科醫師獨立完成，其操作手續簡單易於學習，手術時間短且併發症少，是一安全性高之手術步驟，可應用在需要建立呼吸道的患者。
並列摘要
BACKGROUND: Minimally invasive surgery is the trend of modern surgery. Since Ciaglia et al developed the first percutaneous dilatational tracheotomy (PDT) set in 1985 and, this technique has been shown to be effective and safe in patients requiring long-term ventilatory support. However, the literature pertaining to PDT was mostly published by critical care physicians or anesthesiologists, and the candidates for these studies were usually intubated critically ill patients. In contrast, the patients undergoing tracheotomy by otolaryngologist were more diverse. In our country, the articles for PDT published by otolaryngologist were still lacking. The aim of the study was to demonstrate the feasibility and safety of PDT by otolaryngologist.METHODS: A prospective case series study was initiated on all patients who underwent PDT in our department of otolaryngology between September 2009 and September 2010. All cases were performed by a single otolaryngologist. The database provided patient demographics, indication for procedure, clinical diagnosis, success rate, procedure time, blood loss, and perioperative, postoperative and late complications.RESULTS: 40 PDTs were performed. There were 35 male and 5 female cases. Mean age was 62.4 years. Mean neck circumstance was 41.7 cm. Mean cricosternal distance was 4.1 cm. In preparation for head and neck cancer treatment was the most common indication. Success rate was 100%. Mean procedure time was 5.6 minutes, and the blood lose was minimal in all patients. The total complication rate was 17.5%, and all were considered minor. Perioperative complication was found in one case, which was tracheotomy tube cuff rupture. Postoperative complications were found in 6 cases, with air leak being the most commonly seen in 4 cases, and wound oozing in the other two. With a follow-up period of 1 month, there was no late complication.CONCLUSIONS: PDT can be safely performed by otolaryngologist. PDT is an efficient, safe, easy to learn and quick procedure in patients requiring airway management.